Diabetes Mellitus and Hypoglycaemia Flashcards
What is the main aim of the treatment of diabetes?
To alleviate symptoms and minimise the risk of long-term complications.
How can the increased risk of CVD associated with diabetes be reduced?
By use of an ACEi and lipid-regulating drugs.
What does glycosylated haemoglobin (HbA1c) provide a good indication of? How frequently should it be measured?
Glycaemic control over the past 2-3 months, it should be measured every 3-6 months.
What is the ideal HbA1c concentration to aim for in patients with diabetes? (This is different to the reference range).
59 mmol/L or less.
What is the reference range for HbA1c in a healthy patient?
20-42 mmol/L.
Why is the target HbA1c different in a patient with diabetes compared to the reference range of a healthy patient?
Because it is not always achievable and can lead to an increased risk of severe hypoglycaemic episodes.
How would one test for diabetic nephropathy?
Via urinary microalbuminuria, annual test for urinary proteins, and serum creatinine.
Presence of diabetic nephropathy increases one’s risk of developing which electrolyte abnormality?
Hyperkalaemia.
How should all diabetic patients with diabetic nephropathy be treated?
With ane ACEi or ARB, regardless of blood pressure. Blood pressure should also be carefully monitored to minimise renal deterioration.
What characteristic of ACEi should be taken into account when they are used in patients with diabetes?
They can potentiate the hypoglycaemic effect of anti-diabetic drugs and insulin, especially during initial treatment and in renal failure. Increased risk of hypoglycaemia.
How should mild to moderate pain in diabetic neuropathy be treated?
With paracetamol or ibuprofen.
How should painful diabetic neuropathy be treated?
With duloxetine.
Which drugs can be used if duloxetine is ineffective in treating pain in diabetic neuropathy?
Nortriptyline or amitriptyline (unlicensed).
If duloxetine, amitriptyline, and nortriptyline are all ineffective in treating pain in diabetic neuropathy, which drug can be tried?
Gabapentin.
In severe pain in diabetic neuropathy, there is evidence to suggest which drugs may be effective?
Tramadol. Additionally, morphine and oxycodone may be used under specialist supervision.
What blood sugar level defines hypoglycaemia?
A blood sugar of less than 3.5 mmol/L.
What are the symptoms of hypoglycaemia?
Pale skin, feeling sweaty, tremor, rapid heart rate, confusion, aggression, fits, impaired consciousness.
What is the main aim of treating hypoglycaemia?
Immediate restoration of blood glucose levels.
How is hypoglycaemia treated in a cooperative and conscious patient?
By administration of oral glucose.
How is hypoglycaemia treated in an unconscious patient?
By administration of IV dextrose.
How is hypoglycaemia treated in an unconscious patient with no IV access?
By administration of an IM glucagon injection.
What are the symptoms of diabetic ketoacidosis/hyperosmolar non-ketosis?
Dehydration, acute hunger, thirst, abdominal pain, fruity smelling breath and urine (if ketotic), rapid breathing, confusion, decreased consciousness, and arrhythmias (due to hyper/hypokalaemia).
In which type of diabetes is diabetic ketoacidosis more common?
Type 1.
Which has a higher rate of mortality DKA or HONK?
HONK.
How is DKA defined?
Hyperglycaemia > 20mM with the presence of ketones.
DKA may be exacerbated by the vomiting present in the condition, increasing dehydration and potassium loss. What causes this vomiting?
The presence of ketones irritating the vomiting centre.
In which group of diabetic patients is HONK often seen?
Undiagnosed patients.
Define HONK.
Hyperosmolar non-ketosis. Severe dehydration due to hyperglycaemia > 50mM. Some insulin is present so minimal ketones are seen.
How are DKA and HONK managed?
Use of NG tube to remove stomach contents and prevent aspiration. IV insulin and fluids. Use of LMWH to prevent clotting. Use of a urinary catheter to monitor fluids and assist immobile patients. Use of a sliding scale of insulin to tightly control glucose levels. Fluid, potassium, and phosphate replacement. Consider Abx if caused by infection.
What is the NICE guidance for the treatment for T2DM?
Metformin monotherapy. If contraindicated, consider a gliptin, pioglitazone, or sulfonylurea. Then metformin dual therapy with a gliptin, pioglitazone, or a sulfonylurea. If metformin contraindicated gliptin + pioglitazone, gliptin + sulfonylurea, pioglitazone + sulfonyurea.
